Traditional training programs are NOT doing a very good job. Below is a brief discussion of the research, often sponsored by organizations who conduct the training such as the American Heart Association and the American Red Cross. The research is also conducted by independent individuals long associated with the industry. Top

RESEARCH ON TRAINING OF PROFESSIONALS AND LAY PERSONS

Weakness Identified In Traditional Training

• Teaching methods are antiquated. In a classroom setting, the ER nurse, who performs CPR several times a week, is required to undergo the same instruction as the dermatologist who may have never done so in his or her career. It is impossible to match level of competency with length of training in a classroom course.
• Frequency of retraining is inadequate. The two-year re-certification interval has been established mostly in recognition of the inconvenience in scheduling more frequent instructor-based group classes. It is NOT based on any skills-retention research, all of which concludes that competency begins to erode soon after a course, and there are pronounced deficiencies by 6 months to a year.
• Training is inconsistent. For a fee, and with little to no formal education or training, instructors are certified. Further, there is no organized feedback to evaluate and improve their performance. Many instructors are dedicated and excellent - but many are neither.
• Shortcuts are often taken. Since both the student, who needs the CPR certificate more than the training, and the instructor, who is compensated by numbers of certificates issued rather than quality of training, have the same incentive - to issue a certificate with a minimum of effort. This often results in short courses, inadequate training, and even the outright selling of certificates with no training whatsoever.
• Traditional training is inconvenient. Professionals and lay person's alike dread the every two-year ritual of finding a course, scheduling the time, hoping that the course is not cancelled. Then, rather than focus on individual skills acquisition, students are often intimidated and/or distracted by others.
• Traditional training is a barrier to improving CPR rates and ultimately to improving survival from life-threatening emergencies . With inconveniently scheduled group training that is inconsistent and antiquated, and with insufficient retraining, the continued reliance on traditional instructor-based classroom training has reduced the number and quality of individuals ready to respond and help in an emergency. Many lives have been needlessly lost as a result.
• Traditional training has created an entire generation of healthcare practitioners who do not perform CPR well - and patient care suffers as a result. Several observational studies have shown that hospital and pre-hospital personnel make regular errors in CPR, and that it directly affects patient care. JAMA, Jan 19, 2005 Top

On the other hand FAFA uses sound educational principles and modern technology to bring innovation and consistent results to the teaching of CPR. We bring accuracy and convenience to those who want to be sure they know how to use one.

The AHA reviews research into BLS Instructional Methods, and they refer to the indisputable findings that shows that traditional training shows poor results. They refer to a study which shows that even video instruction has better results than traditional face to face training. In keeping with this research they recommend:

"Instruction methods should not be limited to traditional techniques: newer methods may be more effective. " AHA Circulation 2005 (Part 8: Interdisciplinary Topics)

Research and teaching methods have advanced by huge strides since the first courses teaching people how to perform CPR were introduced. Unfortunately many of the courses that people take still rely on outdated methods. Top

RESEARCH ON LAY PERSON TRAINING

The weaknesses of traditional training for the layperson have been studied and reported by numerous researchers. One can summarize by saying that traditional training methods fail to produce a body of effective competent people who can perform CPR. Here are a few samples of what these investigators say.

"Most people who complete CPR training will not perform effective basic CPR even immediately after training. This is because of (1) inadequate training of instructors who devote too much time to presenting information and too little time to hands-on practice and (2) lack of teaching methods appropriate for lay person's, which has a negative effect both on learning and psychosocial willingness to respond." ILCOR Advisory Statement

There has been a perception that only professionals can make a difference. Response by professionals plays a fundamental role in rescue, and they are a key part of the Emergency Response System and the Chain of Survival. However, response by the lay person is essential; it is the backbone of getting survival rates higher; much better than they are currently. And the research is unanimous in showing that lay responder intervention will save many more lives.

"The number of survivors of sudden cardiac arrest markedly increased when the victims were helped by community volunteers trained to perform not only CPR but also to use an automated external defibrillator (AED)." National Institute of Health Nov 11, 2003 Top

RESEARCH ON AED TRAINING

"There are over 460,000 deaths from "out-of-hospital" cardiac arrest each year in the United States ."

"Increased survival of cardiac arrest victims was primarily found in the CPR plus AED "public" sites ."

"We now have the results of the world's largest test of public access defibrillation. We trained almost 20,000 volunteers. They did an incredible job and there were no major injuries or serious safety issues" Joseph Ornato, MD, Professor, Virginia University Medical Center 's Department of Emergency Medicine." National Institute of Health Nov 11, 2003

ILCOR is an international organization composed of representatives from many different national organizations. Their last advisory statement (Education in Resuscitation, Utstein Abbey, Stavanger Norway) comes from the following participants: European Resuscitation Council, American Heart Association, Heart and Stroke Foundation of Canada, Resuscitation of Southern Africa, The Australian and New Zealand Resuscitation Council, Consejo Latino-Americano de Resuscitation.

Their analysis of the research, put out in their June 2001 statement, is direct and informative. It is a clear indictment of current practices.

"Most victims of cardiac arrest do not receive bystander CPR. When given the quality is far from ideal"

Here is what they find regarding traditional training programs teaching CPR to lay rescuers. This is a summary of the points raised in their reports.

• Skills acquisition after a traditional training program is poor.
• Skills retention after a traditional training program is poor.
• The curriculum is poor
• Instructor training is poor
• Instructors frequently digress
• Students do not receive sufficient time for practice
• Supervision of students is poor
• Feedback to students is poor Top

The essential meaning of the research results is clear. Traditional training has no consideration of educational principles; it lacks clear objectives; it lacks appropriate formats; and it lacks an agreed-on method for evaluation. ILCOR's own summary explicitly states that we must improve CPR training. Top

"Skills acquisition and retention, which are poor, must be improved by simplified procedures and better training methods."

"The need for improvement in the way CPR is taught has received scant attention but should no longer be ignored." ILCOR Advisory Statement

"There are times when learners, instructors, and administrators may find traditional training courses inconvenient due to the realities of everyday working life." American Heart Association, National ECC Training memo, Nov 12, 2003.

In their Circulation 2005 (Part 8: Interdisciplinary Topics) the AHA looked at all of the research relating to training in AED use. The research showed that no single method is more effective than any other training method. Their recommendation is that:

"Community lay responder AED training is recommended."

The AHA specifically does NOT recommend a specific instructional method for AED training. Top

BETTER TESTING REQUIRED

The ILCOR Advisory Statement is an advice produced for those in the field of CPR and first aid training. It was produced to encourage those of us in the industry to improve our methods. They clearly call for improved assessment. In the words of the report:

"Established adult educational principles that encourage simplification should be adopted in resuscitation training."

"Easy accessibility of training is a fundamental requirement that is often overlooked. Training should take place in a comfortable environment."

"Although there has been sporadic research since the 1960s on how effectively students acquire and retain CPR skills, only recently has attention turned to instructor competence and quality and relevance of courses. Much more attention should be given to program development, quality of instruction, and evaluation of results." Top

These statements are not made lightly. They reflect the real difficulties with traditional training programs - and they are based on solid scientific evidence. Here are a few of the references where the original research clearly shows that the current state of training is very poor. Top

•  Chamberlain D, Smith A, Woollard M, et al. Trials of teaching methods in basic life support (3): comparison of simulated CPR performance after first training and at 6 months, with a note on the value of re-training. Resuscitation . 2002;53:179-187

•  Kaye W. Research on ACLS training-which methods improve skill & knowledge retention? Respir Care . 1995;40:538 -546; discussion 546-549.

•  Ward P, Johnson LA, Mulligan NW, et al. Improving cardiopulmonary resuscitation skills retention: effect of two checklists designed to prompt correct performance. Resuscitation . 1997;34:221-225.

•  Kaczorowski J, Levitt C, Hammond M, et al. Retention of neonatal resuscitation skills and knowledge: a randomized controlled trial. Fam Med . 1998;30:705-711.

•  Broomfield R. A quasi-experimental research to investigate the retention of basic cardiopulmonary resuscitation skills and knowledge by qualified nurses following a course in professional development. J Adv Nurs . 1996;23:1016-1023.

•  Dracup K, Doering LV, Moser DK, et al. Retention and use of cardiopulmonary resuscitation skills in parents of infants at risk for cardiopulmonary arrest. Pediatric Nurse . 1998;24:219-225; quiz 226-227.

•  Handley JA, Handley AJ. Four-step CPR-improving skill retention. Resuscitation . 1998;36:3-8. Erratum in: Resuscitation. 1998;37:199

•  Hammond F, Saba M, Simes T, et al. Advanced life support: retention of registered nurses' knowledge 18 months after initial training. Aust Crit Care . 2000;13:99-104.

•  Nolan RP, Wilson E, Shuster M, et al. Readiness to perform cardiopulmonary resuscitation: an emerging strategy against sudden cardiac death. Psychosom Med . 1999;61:546-551.

•  Amith G. Revising educational requirements: challenging four hours for both basic life support and automated external defibrillators. New Horiz . 1997;5:167-172.

•  Su E, Schmidt TA, Mann NC , et al. A randomized controlled trial to assess decay in acquired knowledge among paramedics completing a pediatric resuscitation course. Acad Emerg Med . 2000;7:779-786. Top

NEW TRAINING METHODS REQUIRED

All of us involved in CPR training acknowledge that there are difficulties with retention of skills. The ILCOR Advisory Report puts into writing what we all know; traditional training methods need to be improved.

"Section 6. New Technologies in Training
The general disappointment in skills acquisition and retention after conventional resuscitation programs has shown the need for a change in teaching methods and reduced reliance on instructors."

Traditional training programs which include some hands-on practice on a plastic manikin have NOT been successful. Here are a few references that demonstrate this clearly. Top

References to support this statement. Top

•  Chamberlain D, Smith A, Woollard M, et al. Trials of teaching methods in basic life support (3): comparison of simulated CPR performance after first training and at 6 months, with a note on the value of re-training. Resuscitation . 2002;53:179-187

•  Sanders AB, Berg RA, Burress M, et al. The efficacy of an ACLS training program for resuscitation from cardiac arrest in a rural community. Ann Emerg Med . 1994;23:56-59.

•  Brennan RT, Braslow A. Skill mastery in public CPR classes. Am J Emerg Med . 1998;16:653-657.

•  Donnelly P, Assar D, Lester C. A comparison of manikin CPR performance by lay persons trained in three variations of basic life support guidelines. Resuscitation . 2000;45:195-199.

•  Lester CA, Morgan CL, Donnelly PD, et al. Assessing with CARE: an innovative method of testing the approach and casualty assessment components of basic life support, using video recording. Resuscitation . 1997;34:43-49.

•  Makker R, Gray-Siracusa K, Evers M. Evaluation of advanced cardiac life support in a community teaching hospital by use of actual cardiac arrests. Heart Lung . 1995;24:116-120.

•  Palmisano JM, Akingbola OA, Moler FW, et al. Simulated pediatric cardiopulmonary resuscitation: initial events and response times of a hospital arrest team. Respir Care . 1994;39:725-729.

•  Broomfield R. A quasi-experimental research to investigate the retention of basic cardiopulmonary resuscitation skills and knowledge by qualified nurses following a course in professional development. J Adv Nurs . 1996;23:1016-1023.

•  Dracup K, Doering LV, Moser DK, et al. Retention and use of cardiopulmonary resuscitation skills in parents of infants at risk for cardiopulmonaryarrest. Pediatr Nurs . 1998;24:219-225; quiz 226-227.

•  Handley JA, Handley AJ. Four-step CPR-improving skill retention. Resuscitation . 1998;36:3-8. Erratum in: Resuscitation. 1998;37:199

•  Hammond F, Saba M, Simes T, et al. Advanced life support: retention of registered nurses' knowledge 18 months after initial training. Aust Crit Care . 2000;13:99-104.

•  Young R, King L. An evaluation of knowledge and skill retention following an in-house advanced life support course. Nurs Crit Care . 2000;5:7-14. Top